Insurance Fraud

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Insurance Fraud – Things to Know

Insurance is already a complex and head-scratching affair for regular folks. Being charged with insurance fraud often means an especially stressful affair. But if you've been charged with insurance fraud, don't worry. This page will tell you everything you need to know and explain why a California criminal defense attorney can help you avoid a conviction.

What is Insurance Fraud?

Being charged with insurance fraud can be intimidating. Here's how the crime is defined according to California Penal Code 550 Sections (a)(1),(4)-(7), and (9):

  • The defendant made a fraudulent claim for payment based on a loss or injury to their insurance company, or caused a fraudulent claim to be made AND
  • The defendant knew that the claim was false or fraudulent AND
  • The defendant acted with the intention to defraud

It's fairly straightforward. Insurance fraud only occurs when someone intentionally and knowingly defrauds an insurance company – proof of accidents or lack of knowledge can help protect you from a conviction.

You can be charged with insurance fraud for filing any number of claim types, such as:

  • The defendant falsely claimed payment for a loss due to the theft, damage, destruction, or conversion of a motor vehicle OR
  • The defendant prepared, signed, made, or subscribed to a document with the intent to use that document to support a false or fraudulent claim
  • The defendant made or cause to be made a fraudulent claim for healthcare benefit payments
  • The defendant presented a claim for a healthcare benefit not used on behalf of the person described in the claim (i.e. made a claim for a healthcare payment for another person, then took the money themselves)

What Possible Penalties Exist?

Penalties for all of these related charges can vary immensely based on the type of fraud charged and the amount of money associated with the claim.

When charged as a felony, punishments can include:

  • fines of up to $50,000 or double the amount of the fraud, usually whichever is higher
  • a period of two, three, or up to five years in jail

Alternatively, when charged as a misdemeanor, penalties can include:

  • a fine of $10,000
  • one year in county jail

More specific penalties may be levied based on the type of fraud claim. For example, healthcare benefits insurance fraud claims for amounts of less than $950 could carry penalties like:

  • a fine of $1000
  • six months in county jail

Defenses to Charges of Insurance Fraud

Although all these possible penalties can seem daunting, a good California criminal defense attorney can make use of several strategies to create an effective defense.

No Intent to Defraud

If there's no intent to defraud, there's no conviction. The prosecution will have to prove that the defendant wanted to defraud the company by knowingly presenting a false claim. This requires serious circumstantial evidence.

A Mistake Was Made On Either Party's Part

Another potential defense involves pointing out mistakes in paperwork for filing the insurance claim in the first place. For instance, a person could easily accidentally file a claim for more money than they intended by adding an extra zero. The insurance company could catch wind of this and assume insurance fraud when there was no intent to defraud the company in the first place.

Why You Need a California Criminal Defense Attorney

Insurance fraud cases can be complex and riddled with legalese. Ultimately, they're nightmares to go through alone. The law offices of Peter James Chambers are open and available to you as soon as you give us a call. As Northern California's best criminal defense attorney team, we're ready and able to help you fight your charges with a free consultation.

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“One who sits in judgment of another should feel as though the sword is pointed at their own heart.”

— THE TALMUD —

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